Non-sugar sweeteners (NSS), commonly known as artificial sweeteners, are ingredients that provide a sweet taste with few or no calories. They are found in a wide range of products, from diet sodas and baked goods to savory sauces. For years, these sweeteners have been positioned as a tool for managing calorie intake. Recently, the World Health Organization (WHO) has issued new guidance regarding their use, prompting a re-evaluation of their role in our diets.
The WHO’s Official Guidance
The World Health Organization now advises against the use of non-sugar sweeteners for the purpose of controlling body weight. This new guideline is classified as a “conditional recommendation,” which is used when the evidence for a particular action is not definitive, suggesting that policymakers should engage in substantial discussion before implementation. The guidance applies to the general population, including adults, children, and pregnant women.
This recommendation stems from a comprehensive systematic review of available scientific evidence. The review concluded that using NSS does not provide any long-term benefit in reducing body fat. While some short-term studies indicated a minor reduction in body weight when sweeteners replaced sugar, these effects were not sustained in longer-term studies, which showed no consistent benefit. The WHO’s position is that the small, temporary weight loss observed in controlled settings may not translate to real-world, long-term use.
Health Considerations from the WHO Review
The foundation for the WHO’s new guidance extends beyond the lack of long-term weight management benefits. The systematic review also highlighted potential undesirable health effects associated with long-term consumption of non-sugar sweeteners.
Prolonged use of these sweeteners was associated with an increased risk of developing type 2 diabetes. The review also found a connection between long-term NSS consumption and a higher risk for cardiovascular diseases. Furthermore, the evidence reviewed indicated a possible increase in overall mortality in adults with higher NSS consumption.
It is important to note that the WHO acknowledged a potential for “reverse causation” in these findings. This means that individuals who are already at a higher risk for health problems, such as those with a higher body mass index, might be more likely to choose NSS products as a perceived healthier option, complicating the interpretation of the data.
Scope of the Recommendation
The WHO’s guidance is specific about which sweeteners are included in its recommendation. The advice applies to a wide array of common synthetic and naturally derived non-nutritive sweeteners, including:
- Acesulfame K
- Aspartame
- Advantame
- Cyclamates
- Neotame
- Saccharin
- Sucralose
- Stevia and stevia derivatives
There are important exceptions to this recommendation. The guidance explicitly does not apply to individuals with pre-existing diabetes. The review did not focus on this population, and the management of blood sugar in people with diabetes is a distinct clinical consideration.
The recommendation also does not cover certain categories of products. Low-calorie sugars and sugar alcohols were not part of the WHO’s analysis. Additionally, the guidance does not pertain to personal care and hygiene products that may contain sweeteners, such as toothpaste, skin cream, or medications.
Alternative Approaches to Sugar Reduction
In light of its recommendation against using sweeteners for weight control, the WHO emphasizes alternative strategies for reducing the intake of free sugars. The organization suggests that rather than seeking a substitute for sweetness, individuals should aim to reduce the overall sweetness of their diet. This approach is recommended to begin from an early age to help shape long-term taste preferences.
The primary alternative proposed is to shift consumption toward foods containing naturally occurring sugars. This includes prioritizing whole fruits, which provide sugars along with fiber, vitamins, and minerals.
Ultimately, the WHO encourages choosing unsweetened foods and beverages. This strategy directly addresses the root of the issue by decreasing the reliance on sweet tastes altogether, whether from sugar or from substitutes.